Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review

Abstract

Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication can be identified; the length of time the lesion has been present; the frequency of episodes in recurrent cases; the presence or absence of pain; and the growth of the lesion over time. For multiple or recurrent lesions the presence or history of ulcers on the skin, genital areas, or eyes should be evaluated along with any accompanying systemic symptoms such as fever, arthritis, or other signs of underlying systemic disease. Biopsy may be indicated in many ulcerative lesions of the oral cavity although some are more suitable for clinical diagnosis. Neoplastic ulcerated lesions are notorious in the oral cavity for their ability to mimic benign ulcerative lesions, highlighting the essential nature of biopsy to establish a diagnosis in cases that are not clinically identifiable or do not respond as expected to treatment. Adjunctive tests may be required for final diagnosis of some ulcerated lesions especially autoimmune lesions. Laboratory tests or evaluation to rule out systemic disease may be also required for recurrent or severe ulcerations especially when accompanied by other symptoms. This discussion will describe the clinical and histopathologic characteristics of a variety of ulcerated lesions found in the oral cavity.

http://bit.ly/2FZue3A

Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review

Abstract

Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication can be identified; the length of time the lesion has been present; the frequency of episodes in recurrent cases; the presence or absence of pain; and the growth of the lesion over time. For multiple or recurrent lesions the presence or history of ulcers on the skin, genital areas, or eyes should be evaluated along with any accompanying systemic symptoms such as fever, arthritis, or other signs of underlying systemic disease. Biopsy may be indicated in many ulcerative lesions of the oral cavity although some are more suitable for clinical diagnosis. Neoplastic ulcerated lesions are notorious in the oral cavity for their ability to mimic benign ulcerative lesions, highlighting the essential nature of biopsy to establish a diagnosis in cases that are not clinically identifiable or do not respond as expected to treatment. Adjunctive tests may be required for final diagnosis of some ulcerated lesions especially autoimmune lesions. Laboratory tests or evaluation to rule out systemic disease may be also required for recurrent or severe ulcerations especially when accompanied by other symptoms. This discussion will describe the clinical and histopathologic characteristics of a variety of ulcerated lesions found in the oral cavity.

http://bit.ly/2FZue3A

Check out the ten Top-viewed articles in 2018 – Clinical Thyroidology for the Public

1. THYROID HORMONE THERAPY Taking levothyroxine with breakfast may be fine for many patients
Volume 6 Issue 11
Heather Hofflich, DO
90,612 views

2. THYROID NODULES Risk of thyroid cancer based on thyroid ultrasound findings
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Jamshid Farahiti, MD
86,024 views

3. HYPOTHYROIDISM Desiccated thyroid extract vs Levothyroxine in the treatment of hypothyroidism
Volume 6 Issue 8
Angela M. Leung, MD, MSc
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4. THYROID CANCER High risk of thyroid cancer in patients with multinodular goiter
Volume 6 Issue 11
Jamshid Farahiti, MD
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5. HYPOTHYROIDISM When is the best time to take thyroid hormone?
Volume 4 Issue 5
Whitney Woodmansee, MD
46,413 views

6. THYROID AND PREGNANCY First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss
Volume 3 Issue 8
Whitney Woodmansee, MD
34,091 views

7. THYROID HORMONE TESTS Determination of optimal TSH ranges for reflex Free T4 testing
Volume 11 Issue 2
Whitney W. Woodmansee MD
22,787 views

8. HYPERTHYROIDISM Thyroid tests on newborns within the first five days will detect neonatal hyperthyroidism
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Heather Hofflich, DO
21,568 views

9. THYROID AND PREGNANCY Low TSH levels early on in pregnancy may be normal
Volume 9 Issue 10
Alan P. Farwell, MD, FACE
21,047 views

10. THYROID AND PREGNANCY Increasing levothyroxine doses early in pregnancy is associated with a lower risk for pregnancy loss in hypothyroid women
Volume 9 Issue 10
Shirin Haddady, MD
20,502 views

 

The post Check out the ten Top-viewed articles in 2018 – Clinical Thyroidology for the Public appeared first on American Thyroid Association.

http://bit.ly/2RsRY1w

Syndromes that predispose to epistaxis

Abstract

Purpose

Our aim was to evaluate if epistaxis is directly associated with the etiology or pathophysiological mechanism which results in the syndrome itself or arises as a secondary effect.

Methods

We performed an extensive literature review of the web-based PubMed database from the National Library of Medicine to ascertain syndromes related to this condition. Etiology, pathophysiological mechanisms, occurrence, clinical features and management were noted for each of these syndromes.

Results

Epistaxis is commonly seen in syndromes that are usually directly related to vascular abnormalities or coagulation defects. However, in some cases, it is not.

Discussion and conclusion

Since a number of these syndromes are rare and elaborate tests are not carried out in the absence of a positive family history or until other specific clinical features appear, a risk of underdiagnosis and the dilemma of whether epistaxis is specifically related to the syndrome or a secondary effect still remains.

http://bit.ly/2UorUGo

Dietary behaviors and survival in people with head and neck cancer: Results from Head and Neck 5000

Abstract

Background

The association between diet and head and neck cancer (HNC) survival is unclear.

Methods

Cox proportional hazard models measured the association between fruit, vegetable, and deep‐fried food intake and HNC overall survival adjusting for clinical, social and lifestyle variables including smoking, alcohol, and HPV status.

Results

Fruit and vegetable intake and improved survival were associated in minimally adjusted analyses. Following adjustment for smoking and alcohol consumption (fully adjusted analyses), the association with survival disappeared for fruit (HR 0.91, 95% CI 0.67, 1.23; P for trend = .55) and attenuated for vegetables (HR 0.79, 95% CI 0.61, 1.03; P for trend = .04). We observed no association between survival and deep‐fried food intake in minimally adjusted or fully adjusted analyses (HR 0.88 95% CI 0.72, 1.07; P for trend = .13).

Conclusions

Vegetable intake and HNC survival are modestly associated. There is some confounding by tobacco and alcohol consumption.

http://bit.ly/2WuQ1oP

Patient‐defined duration of benefit from juvederm (hyaluronic acid) used in injection laryngoplasty

Objectives/Hypothesis

Injection laryngoplasty has become valuable in treating laryngologic disorders including vocal cord atrophy, paralysis, and paresis. Although materials such as carboxymethylcellulose and calcium hydroxylapatite are Food and Drug Administration (FDA) approved, they are not without limitations. Juvederm (hyaluronic acid) is an alternative treatment that is not FDA approved. Although studies have examined Juvederm's longevity in cutaneous injections, there are limited data examining durability of Juvederm used in laryngoplasty. We aimed to determine the longevity and effectiveness of Juvederm used in injection laryngoplasty.

Study Design

Retrospective cohort study.

Methods

Subjects who underwent injection laryngoplasty using Juvederm were reviewed. Longevity was defined as the time between injection and the date that a patient first noted subjective deterioration of their voice. All subjects were subsequently followed using videostroboscopy to evaluate for Juvederm resorption. Longevity was analyzed using a Kaplan‐Meier survival model, and effectiveness of laryngoplasty was determined using the Voice‐Related Quality of Life index scores and analyzed using a Wilcoxon signed ranks test.

Results

Fifty‐nine subjects met inclusion criteria and underwent Juvederm injection laryngoplasty. Kaplan‐Meier survival analysis revealed a mean longevity of 10.6 months (95% confidence interval: 9.1‐12.0 months). Wilcoxon signed ranks analysis of the pre‐ and postinjection Voice Related Quality of Life (VRQOL) scores revealed improvement, with a mean preinjection VRQOL of 49.2 (standard deviation [SD] = 25.8) and mean postinjection VRQOL of 68.2 (SD = 27.5) (P < .001).

Conclusions

Injection laryngoplasty using Juvederm is an effective treatment for vocal cord atrophy, paralysis, and paresis. Knowledge of the patient‐defined duration of benefit following laryngoplasty using Juvederm plays an important role in counseling patients as well as in the planning of future interventions.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2FYZShN

Clinicopathological significance of tumor cyclin D1 expression in oral cancer

Publication date: Available online 30 January 2019

Source: Archives of Oral Biology

Author(s): Pablo Ramos-García, Miguel Ángel González-Moles, Lucía González-Ruiz, Ángela Ayén, Isabel Ruiz-Ávila, Manuel Bravo, José Antonio Gil-Montoya

Abstract

Objective

To evaluate the association of cyclin D1 overexpression with clinicopathological parameters classically considered of prognostic value in OSCC (T, N, M, clinical stage, degree of differentiation, invasive morphology and, cellular proliferation index).

Design

A retrospective immunohistochemical study was conducted of cyclin D1 and ki-67 expression in 68 OSCCs from 54 patients. Cases were scanned using a digital pathology system. The tumor expression of markers was assessed in four randomly selected fields (40x), and a semi-automatized count was conducted of cyclin D1-positive and -negative cells.

Results

Cyclin D1 overexpression was found in 28.7% of the cases of OSCC. It was significantly and positively associated with the following clinicopathological parameters: low tumor differentiation degree (p = 0.030), invasive morphology (p = 0.045), and proliferative phenotype according to tumor cell ki-67 expression(p = 0.018).

Conclusions

Cyclin D1 overexpression is an event of oral carcinogenesis associated with clinicopathological parameters classically associated with a poor prognosis in patients with OSCC.

http://bit.ly/2UsJSrg

Deletion of cas3 gene in Streptococcus mutans affects biofilm formation and increases fluoride sensitivity

Publication date: Available online 29 January 2019

Source: Archives of Oral Biology

Author(s): Boyu Tang, Tao Gong, Xuedong Zhou, Miao Lu, Jumei Zeng, Xian Peng, Shida Wang, Yuqing Li

Abstract

Objective

The goal of this study was to analyze the impact of cas3 gene on the biofilm formation and virulence gene expression in S. mutans, since our previous studies have found a connection between CRISPR/Cas systems and biofilm formation in S. mutans.

Methods

The cas3 gene in-frame deletion strains of S. mutans UA159 was constructed by a two-step transformation procedure and the cas3 mutant strain was complemented in trans. The biofilm biomass was measured by crystal violet staining, and the synthesis of exopolysaccharides (EPS) was measured by the anthrone-sulfuric method. Biofilm analysis and structural imaging was using confocal laser scanning microscope (CLSM) and scanning electron microscope (SEM) assays. The fluorescence in situ hybridization (FISH) was used to analyze the spatiotemporal interactions between S. mutans and Streptococcus sanguinis. Fluoride sensitivity was determined using fluoride tolerance assays. The expression of biofilm formation related genes was evaluated by qRT-PCR.

Results

Our results showed that S. mutans cas3 deletion strain formed less biofilm and became less competitive when it was co-cultured with S. sanguinis under fluoride treatment. The expression levels of virulence genes including vicR, gtfC, smu0630 and comDE were significantly downregulated.

Conclusions

The cas3 gene in S. mutans could regulate biofilm formation and fluoride resistance, consequently affecting S. mutans competitiveness in a dual-species biofilm model under fluoride treatment. These results also provide a potential strategy for enhancing fluoride specificity, with cas3 gene as a potential genetic target in the modulation of oral microecology and the treatment of dental caries.

http://bit.ly/2DJ1NEA

Bismuth supplements as the first‐line regimen for Helicobacter pylori eradication therapy: Systemic review and meta‐analysis

Abstract

Background and Aims

An increase in the use of antibiotics leads to increased antibiotic resistance of Helicobacter pylori (H pylori). Consequently, it has been considered that the first‐line standard regimen should be changed. The main purpose of this study was to evaluate the efficacy of nonantibiotic (bismuth) supplements as a first‐line regimen for H pylori eradication.

Methods

We searched PubMed, EMBASE, CINAHL, and the Cochrane Library databases for randomized controlled trials (RCTs) reported in English and undertaken up until August 2018. A meta‐analysis of all randomized controlled trials comparing bismuth supplements with non‐bismuth‐containing regimens in H pylori eradication was performed. RCTs of classic bismuth‐containing quadruple therapy as a first‐line regimen were excluded.

Results

We identified twenty‐five randomized trials (3990 patients), and the total H pylori eradication rate, according to per protocol analyzed, was 85.8%. The odds ratio was 1.83 (95% confidence interval (CI). 1.57‐2.13). Among these RCTs, there were 7 RCTs for bismuth add‐on therapy, and the odds ratio was 2.81 (95% CI. 2.03‐3.89). When the studies were performed in a high clarithromycin resistance area (≥15%) or included patients with clarithromycin resistance, bismuth‐containing regimens were superior to non‐bismuth regimens. Moreover, the incidence of total side effects was insignificant.

Conclusions

Bismuth supplements as a first‐line regimen could be effective, with bismuth add‐on regimens being the most effective. Particularly, bismuth supplements showed the potential efficacy for clarithromycin‐resistant strains and would be the most viable alternative in clinical practice.

http://bit.ly/2TlKkrt

Detecting the recruitment phenomenon in adults using 80-Hz auditory steady-state response

Publication date: Available online 29 January 2019

Source: Auris Nasus Larynx

Author(s): Toshinori Kubota, Tsukasa Ito, Yasuhiro Abe, Hiroyuki Chiba, Yutaka Suzuki, Seiji Kakehata, Masaru Aoyagi

Abstract

Objectives

The ASSR is used widely as an objective measurement of hearing in clinical settings because of its high frequency specificity. The recruitment phenomenon is generally detected using subjective evaluations which require direct communication with the patient. If the recruitment phenomenon can be detected with ASSR, it would facilitate diagnosis in patients with developmental disorders and infants.

Subjects and methods

We examined 2 groups of subjects: 10 subjects with unilateral hearing impairment in whom the recruitment phenomenon was detected by the alternate binaural loudness balance test and 12 normal subjects. We compared the relationships between the ASSR response and the stimulus sound pressure level in the 2 groups using the 80-Hz ASSR.

Results

The amplitude of ASSR was significantly higher in the impaired ear in hearing-impaired subjects compared to a normal ear in normal subjects. The latency of ASSR was significantly shorter in the impaired ear in hearing-impaired subjects than in the normal ear in the normal subjects.

Conclusion

This study showed that the recruitment phenomenon caused the higher amplitude and the shorter latency observed in hearing-impaired subjects in the 80-Hz auditory steady-state response (ASSR) in comparison with normal subjects.

http://bit.ly/2HG9tM6

Outcomes following radiation for cutaneous squamous cell carcinoma of the head and neck: Associations between immune suppression and recurrence

Abstract

Background

Data evaluating outcomes and patterns of recurrence following radiation therapy (RT) for cutaneous squamous cell carcinoma (cSCC) of the head and neck are limited.

Methods

We performed a retrospective analysis of 111 head and neck cSCC patients treated with RT at 4 affiliated institutions.

Results

With median follow‐up of 7 months, there were 29 (26%) recurrences, 73% of which were nodal (n = 21). Immunosuppression (IS) was the only factor associated with recurrence (47% in IS, 22% in non‐IS, P = .04), and also with time to recurrence in multivariate analysis (HR 5.5; P = .03). No factors were associated with recurrence among patients who received definitive RT. The majority of patients who recurred were salvaged with surgery (n = 20, 69%).

Conclusion

In a cohort of cSCC treated with radiotherapy, there was an association between IS and increased failure risk. The majority of failures were salvaged surgically.

http://bit.ly/2HN5Jsm